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Verdel N, Nograšek N, Drobnič M, Papuga I, Strojnik V, Supej M. Influence of running speed, inclination, and fatigue on calcaneus angle in female runners. Front Physiol 2025; 16:1505263. [PMID: 40271215 PMCID: PMC12014629 DOI: 10.3389/fphys.2025.1505263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 03/27/2025] [Indexed: 04/25/2025] Open
Abstract
Running is a popular form of physical activity with significant health benefits, but improper technique can lead to running-related injuries. This study investigates the influence of running speed, incline, and fatigue on calcaneus eversion/inversion angle at heel strike, maximum eversion angle, and range of motion, factors associated with lower limb injuries. Fifteen injury-free female runners participated in this study. Kinematic data were collected using a 3D motion capture system with reflective markers placed directly on the skin through specially modified running shoes. The runners performed treadmill trials at varying speeds (10, 12, and 14 km/h) and inclines (0°, 5°, and 10°), both before and after a fatigue-inducing 30-min run. The results indicate that higher speeds were associated with an increase in inversion angle at heel strike (p = 0.05) and range of motion (p = 0.02 before fatigue), both of which are linked to chronic ankle instability and Achilles tendinopathy. Running at an incline reduced both maximum eversion angle (p = 0.002 after fatigue) and range of motion (p = 0.003 after fatigue), suggesting a protective effect against excessive eversion. Fatigue increased range of motion (p = 0.05), which is a risk factor for instability and overuse injuries. These findings suggest that running at higher speeds and in a fatigued state may increase the likelihood of injuries due to increased range of motion, whereas incline running may mitigate this risk by reducing excessive eversion and range of motion. Understanding these biomechanical changes can inform injury prevention strategies for runners.
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Affiliation(s)
- Nina Verdel
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- Department of Communication Systems, Jozef Stefan Institue, Ljubljana, Slovenia
| | - Neža Nograšek
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- Deparment of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Miha Drobnič
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Irinej Papuga
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Vojko Strojnik
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Matej Supej
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
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de Oliveira LN, Durigan JLQ, Sanchez CR, Mansur H, Rosa ABB, Marqueti RDC. MRI-Based Morphometric Comparison of Lower Leg Muscles and Tendons in Individuals With Medial Tibial Stress Syndrome. BIOMED RESEARCH INTERNATIONAL 2024; 2024:8827692. [PMID: 39717266 PMCID: PMC11666316 DOI: 10.1155/bmri/8827692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 12/02/2024] [Indexed: 12/25/2024]
Abstract
Runners frequently suffer from medial tibial stress syndrome (MTSS), often linked to excessive eccentric muscle contractions causing periosteal traction by the muscles in the deep posterior compartment. However, the effects of MTSS on these muscles and tendons remain underexplored. This study is aimed at investigating changes in muscle and tendon volumes in this compartment, as well as cross-sectional area measurements, using magnetic resonance imaging. Thirty individuals were divided into two groups: MTSS (n = 18; mean age 30.3 ± 12.4) and control (n = 12; age 35.2 ± 9.2). The anterior, deep posterior, superficial posterior, and lateral compartment muscles, along with their respective tendons, were compared between groups, and possible sex differences were also evaluated. The deep posterior compartment showed a significant volume difference of 0.41 cm3/kg3/4 in the MTSS group (p = 0.034), primarily due to the flexor hallucis longus (FHL), which had a 0.55 cm3/kg3/4 greater normalized volume (17.12% greater mean muscle volume) compared to controls (p = 0.023; Cohen d = 0.895). No association between sex and MTSS was found (p = 0.752). In conclusion, the FHL muscle exhibited increased normalized volume in the MTSS group compared to controls, with no sex-related differences in MTSS. Clinicians should consider the assessment of FHL muscle volume in routine evaluations of patients presenting with symptoms suggestive of MTSS.
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Affiliation(s)
- Lucas Nogueira de Oliveira
- Orthopaedic and Trauma Unit, Hospital de Base, Brasília, Distrito Federal, Brazil
- Laboratory of Molecular Analysis, Graduate Program in Rehabilitation Science, Faculdade de Ciências da Saúde e Tecnologias, Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | - João Luiz Quagliotti Durigan
- Laboratory of Muscle and Tendon Plasticity, Graduate Program in Rehabilitation Science, Faculdade de Ciências da Saúde e Tecnologias, Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | | | - Henrique Mansur
- Orthopaedic Group, DF Star Hospital-Rede D'or, Brasília, Distrito Federal, Brazil
| | | | - Rita de Cássia Marqueti
- Laboratory of Molecular Analysis, Graduate Program in Rehabilitation Science, Faculdade de Ciências da Saúde e Tecnologias, Universidade de Brasília, Brasília, Distrito Federal, Brazil
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Lashien SA, Abdelnaeem AO, Gomaa EF. Effect of hip abductors training on pelvic drop and knee valgus in runners with medial tibial stress syndrome: a randomized controlled trial. J Orthop Surg Res 2024; 19:700. [PMID: 39468623 PMCID: PMC11520670 DOI: 10.1186/s13018-024-05139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 10/03/2024] [Indexed: 10/30/2024] Open
Abstract
BACKGROUND Medial tibial stress syndrome (MTSS) is a prevalent running-related injury that could impact athletic performance and quality of life. The purpose of the study was to investigate the effectiveness of functional hip abductor strength training on reducing contralateral pelvic drop angle (hip frontal plane projection angle), and dynamic knee valgus (knee frontal plane projection angle) in runners with medial tibial stress syndrome (MTSS). METHODS Forty male and female recreational runners were diagnosed with MTSS for at least one month. The age ranged from 25 to 35 years old, and the body mass index (BMI) ranged between (18.5 and 25 kg/m2) participated in this study. This was a single-blind, randomized controlled trial. Participants were randomized into two groups: a control group (Group A, n = 20) received a selected physical therapy exercise program, and an experimental group (Group B, n = 20) received the same program plus functional hip abductor strength training. Dynamic knee valgus (frontal plane projection angle) and contralateral pelvic drop angle were measured using 2D video and analyzed by Kinovea software at baseline and after 8 weeks. Mixed-effect multifactor analysis of variance (MANOVA) was conducted to compare within and between groups effects on FPPA and pelvic drop angle. RESULTS After 8 weeks, Group B exhibited a significantly decreased frontal plane projection and pelvic drop angles compared to Group A (p < 0.05). Group A also demonstrated a reduced pelvic drop angle, but to a lesser extent, and their frontal plane projection angle increased. CONCLUSIONS This study demonstrates that 8 weeks of functional hip abductor strength training, combined with traditional physical therapy, effectively improves lower extremity kinematics in runners with MTSS by reducing dynamic knee valgus and contralateral pelvic drop. This targeted approach likely addresses underlying muscle weakness and movement dysfunction, offering hope for potentially reducing MTSS recurrence. TRIAL REGISTRATION clinicaltrials.gov. NO: NCT05637476. Date: December 1, 2022.
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Affiliation(s)
- Shreen Ahmed Lashien
- Department of Orthopedic Physical Therapy, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
| | - Ahmed Omar Abdelnaeem
- Department of Orthopedic Physical Therapy, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Ebtessam Fawzy Gomaa
- Department of Orthopedic Physical Therapy, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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Colli D, Tarantino AG, Bergna A, Vismara L. Management of medial tibial stress syndrome with osteopathic manipulative treatment in a basketball player: Case report. J Bodyw Mov Ther 2024; 40:1527-1530. [PMID: 39593482 DOI: 10.1016/j.jbmt.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/27/2024] [Accepted: 08/02/2024] [Indexed: 11/28/2024]
Abstract
INTRODUCTION Medial Tibial Stress Syndrome (MTSS) is one of the most common and disabling leg injuries in military personnel and in athletes participating in sports that involve running and jumping. The objective of this case report was to verify the efficacy of osteopathic manipulation as sole treatment in a basketball player suffering from Medial Tibial Stress Syndrome (MTSS). STUDY TYPE Case report. CASE PRESENTATION The patient in the study was a 26-year-old basketball player who reported a 6-week history of MTSS pain. MTSS diagnosis was made clinically, based on the patient's medical history and pain on palpation. A postural and biomechanical evaluation was also performed in order to study the patient's gait cycle and identify possible risk factors for MTSS. MTSS treatment is mainly conservative. From the initial diagnosis to the end of the follow-up period, no other therapy was performed other than osteopathic manipulative treatment. Overall positive results were obtained after a 2-month follow-up: VAS scores gradually decreased pain during exercise and daily activities diminished and an increase of game statistics was recorded. CONCLUSIONS Considering the results obtained, osteopathic manipulative treatment has proven highly efficient in the treatment of MTSS, without the use of drugs and a decisive role in avoiding suspension from sports.
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Affiliation(s)
- Davide Colli
- Department of Clinical Research, SOMA Istituto Osteopatia Milano, Milan, Italy
| | - Andrea Gianmaria Tarantino
- Department of Clinical Research, SOMA Istituto Osteopatia Milano, Milan, Italy; Division of Paediatric Manima Non-Profit Organization Social Assistance and Healthcare, Milan, Italy
| | - Andrea Bergna
- Department of Clinical Research, SOMA Istituto Osteopatia Milano, Milan, Italy
| | - Luca Vismara
- IRCCS Istituto Auxologico Italiano, Division of Neurology and Neurorehabilitation, Piancavallo-Verbania, Italy.
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Ramteke SU, Jaiswal PR. Physical Therapy Perspectives for Medial Tibial Stress Syndrome in a Novice Runner: A Case Report. Cureus 2024; 16:e67647. [PMID: 39314590 PMCID: PMC11417438 DOI: 10.7759/cureus.67647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 08/23/2024] [Indexed: 09/25/2024] Open
Abstract
Medial tibial stress syndrome (MTSS), commonly referred to as shin splints, is a prevalent overuse injury observed in runners, particularly those who are inexperienced. This condition is marked by pain along the distal anteromedial region of the tibia, often resulting from repetitive stress and insufficient adaptation of the musculoskeletal system. This case report examines the physical therapy strategies utilized in the evaluation and management of MTSS in a novice runner. The subject of the study was a 22-year-old male novice runner who reported severe pain along the medial side of the tibia, which intensified during running activities. The physical therapy approach adopted was multifaceted, incorporating initial pain relief, relative rest, and a focus on strengthening and enhancing flexibility in the lower extremities, alongside proprioceptive training and mobilization techniques. A significant emphasis was placed on educating the patient. The patient participated in a progressive loading program designed to facilitate tissue healing and reduce the likelihood of recurrence. Over a span of six weeks, the patient exhibited considerable improvement in both symptoms and pain levels. Functional evaluations revealed increased strength and flexibility in the lower extremities. This case report underscores the effectiveness of comprehensive physical therapy interventions in the management of MTSS among novice runners. Thorough clinical assessments and customized rehabilitation programs were essential in addressing underlying issues and fostering recovery. These results highlight the necessity of personalized rehabilitation strategies to optimize treatment outcomes for individuals suffering from MTSS.
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Affiliation(s)
- Swapnil U Ramteke
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratik R Jaiswal
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Ye D, Li L, Zhang S, Xiao S, Sun X, Wang S, Fu W. Acute effect of foot strike patterns on in vivo tibiotalar and subtalar joint kinematics during barefoot running. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:108-117. [PMID: 37220811 PMCID: PMC10818114 DOI: 10.1016/j.jshs.2023.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/07/2022] [Accepted: 02/28/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Foot kinematics, such as excessive eversion and malalignment of the hindfoot, are believed to be associated with running-related injuries. The majority of studies to date show that different foot strike patterns influence these specific foot and ankle kinematics. However, technical deficiencies in traditional motion capture approaches limit knowledge of in vivo joint kinematics with respect to rearfoot and forefoot strike patterns (RFS and FFS, respectively). This study uses a high-speed dual fluoroscopic imaging system (DFIS) to determine the effects of different foot strike patterns on 3D in vivo tibiotalar and subtalar joints kinematics. METHODS Fifteen healthy male recreational runners underwent foot computed tomography scanning for the construction of 3-dimensional models. A high-speed DFIS (100 Hz) was used to collect 6 degrees of freedom kinematics for participants' tibiotalar and subtalar joints when they adopted RFS and FFS in barefoot condition. RESULTS Compared with RFS, FFS exhibited greater internal rotation at 0%-20% of the stance phase in the tibiotalar joint. The peak internal rotation angle of the tibiotalar joint under FFS was greater than under RFS (p < 0.001, Cohen's d = 0.92). RFS showed more dorsiflexion at 0%-20% of the stance phase in the tibiotalar joint than FFS. RFS also presented a larger anterior translation (p < 0.001, Cohen's d = 1.28) in the subtalar joint at initial contact than FFS. CONCLUSION Running with acute barefoot FFS increases the internal rotation of the tibiotalar joint in the early stance. The use of high-speed DFIS to quantify the movement of the tibiotalar and subtalar joint was critical to revealing the effects of RFS and FFS during running.
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Affiliation(s)
- Dongqiang Ye
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China
| | - Lu Li
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China.
| | - Shen Zhang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China
| | - Songlin Xiao
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China
| | - Xiaole Sun
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China
| | - Weijie Fu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China; Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai 200438, China.
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Akuzawa H, Imai A, Iizuka S, Matsunaga N, Kaneoka K. Contribution of the tibialis posterior and peroneus longus to inter-segment coordination of the foot during single-leg drop jump. Sports Biomech 2023; 22:1430-1443. [PMID: 32865130 DOI: 10.1080/14763141.2020.1806347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
Abnormal foot motion is considered to be related to sports related injuries. This study aimed to identify the relationship between calf muscle activity and inter-segment coordination of the foot during single-leg drop jumps. Eleven healthy men participated and performed single-leg drop jumps from a 30-cm box. Muscle activity of the tibialis posterior (TP), flexor digitorum longus, peroneus longus (PL) and gastrocnemius were measured. The rearfoot and midfoot segment angle from landing to leaping were calculated according to the Rizzoli Foot Model and time scaled to 100%. A modified vector coding technique was employed to classify inter-segment coordination of every 1% into four patterns (in-phase, anti-phase, rearfoot phase,and midfoot phase). The relationship between percentage of each pattern and muscle activity levels were statistically analysed with correlation coefficient. The TP showed a significant positive correlation with percentage of in-phase in coronal plane (r = 0.61, p = 0.045). The PL also showed a trend of positive correlation to in-phase in coronal plane (r = 0.59, p = 0.058). TP and PL muscle activities may modulate the inter-segment coordination between the rearfoot and midfoot in coronal plane. Clinically, these muscles should be assessed for abnormal inter-segment foot motion.
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Affiliation(s)
- Hiroshi Akuzawa
- Department of Sports Science, Japan Institute of Sport Sciences, Tokya, Saitama, Japan
| | - Atsushi Imai
- Faculty of Health and Medical Sciences, Aichi Shukutoku University, Nagakute, Aichi, Japan
| | - Satoshi Iizuka
- Department of Sports Science, Japan Institute of Sport Sciences, Tokya, Saitama, Japan
| | - Naoto Matsunaga
- General Education Core Curriculum Division, Seigakuin University, Ageo, Saitama, Japan
- Waseda Institute for Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Koji Kaneoka
- Department of Sports Science, Japan Institute of Sport Sciences, Tokya, Saitama, Japan
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Mendes-Cunha S, Moita JP, Xarez L, Torres J. Dance-related musculoskeletal injury leading to forced time-loss in elite pre professional dancers - a retrospective study. PHYSICIAN SPORTSMED 2023; 51:449-457. [PMID: 36166373 DOI: 10.1080/00913847.2022.2129503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Describe the epidemiology of dance-related musculoskeletal injury leading to forced time-loss in elite pre-professional dancers and provide descriptive data on the prevalence concerning diagnoses, location, and injury type, stratified by gender and skill level. METHODS Retrospective cohort, over a 3-year period on a full-time pre-professional Portuguese dance school featuring 70 both gender students with a mean age of 14.87 years. A total of 110 injuries were analyzed. Non-parametric statistics were used. RESULTS The most prevalent diagnosis leading to forced time-loss in female dancers were Medial Tibial Stress Syndrome (MTSS), 14.29%, and Posterior Ankle Impingement Syndrome (PAIS), 7.14%, whereas in male dancers these were Hallux Sprain, 17.50%, and Lumbar Spine Joint Injuries, 7.50%. Differences were found in injuries' anatomical location between genders and in Incidence Proportion and Clinical Incidence between skill levels. 72.20% of the chronic injuries and 50.00% of the acute injuries occurred in Level III students. CONCLUSIONS With respect to forced time-loss injuries, male dancers were found to sustain more acute traumatic injuries and female dancers overuse, respectively, sprains and MTSS and PAIS. Identifying which injuries are most likely to lead to forced time-loss may be useful for helping health-care professionals in clinical decision-making and in developing more effective injury prevention and management strategies.
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Affiliation(s)
| | - J P Moita
- Higher School of Health (ESSATLA), Barcarena, Portugal
- Dance School of the National Conservatory, Portugal
| | - L Xarez
- Motor Behaviour's Lab, Faculty of Human Motricity, University of Lisbon, Cruz Quebrada, Portugal
| | - J Torres
- Faculty of Medicine, University of Porto, Porto, Portugal
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Tan DS, Cheung FM, Ng D, Cheung TLA. Femoral neck stress fracture and medial tibial stress syndrome following high intensity interval training: A case report and review of literature. World J Clin Cases 2022; 10:8323-8329. [PMID: 36159550 PMCID: PMC9403697 DOI: 10.12998/wjcc.v10.i23.8323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/25/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Femoral and tibial stress injuries are commonly found in long distance running athletes. Stress fractures have rarely been reported in athletes performing high intensity interval training (HIIT) exercise. The objective of this study was to report a case of a patient who presented with medial tibial stress syndrome and femoral neck stress fracture after performing HIIT exercises.
CASE SUMMARY A 26 year old female presented with bilateral medial tibial pain. She had been performing HIIT exercise for 45 min, five times weekly, for a seven month period. Her tibial pain was gradual in onset, and was now severe and worse on exercise, despite six weeks of rest. Magnetic resonance imaging (MRI) revealed bilateral medial tibial stress syndrome. As she was taking norethisterone for birth control, a dual energy X-ray absorbitometry scan was performed which demonstrated normal bone mineral density of her lumbar spine and femoral neck. She was managed conservatively with analgesia and physiotherapy, but continued to exercise against medical advice. She presented again six months later with severe right hip pain. MRI of her right hip demonstrated an incomplete stress fracture of her subtrochanteric region. Her symptoms resolved with strict rest and physiotherapy.
CONCLUSION HIIT may cause stress injury of the tibia and femur in young individuals.
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Affiliation(s)
- Dawn Suwanie Tan
- Department of Orthopaedic Surgery, International Orthopaedic Clinic, Singapore, 329563, Singapore
| | - Fiona Millicent Cheung
- Department of Orthopaedic Surgery, International Orthopaedic Clinic, Singapore, 329563, Singapore
| | - Dekai Ng
- Department of Orthopaedic Surgery, International Orthopaedic Clinic, Singapore, 329563, Singapore
| | - Tin Lung Alan Cheung
- Department of Orthopaedic Surgery, International Orthopaedic Clinic, Singapore, 329563, Singapore
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Zhang H, Peng W, Qin C, Miao Y, Zhou F, Ma Y, Gao Y. Lower Leg Muscle Stiffness on Two-Dimensional Shear Wave Elastography in Subjects With Medial Tibial Stress Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1633-1642. [PMID: 34617298 DOI: 10.1002/jum.15842] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES We aimed to explore, which muscle stiffness changes may be related to medial tibial stress syndrome (MTSS) and the correlation between the medial tibial periosteal thickness and lower leg muscle stiffness. METHODS This study included 63 subjects distributed into 3 groups: the symptomless group, the MTSS group, and the control group. The lower leg muscle stiffness of the tibialis anterior (TA), extensor digitorum longus (EDL), peroneus longus (PL), soleus (SOL), lateral gastrocnemius (LG), medial gastrocnemius (MG), tibialis posterior (TP), and flexor digitorum longus (FDL) in the 3 groups was obtained by two-dimensional shear wave elastography. Differences in the muscle stiffness and medial tibial periosteal thickness in the 3 groups were determined by one-way analysis of variance (ANOVA) and least significant difference tests. The relationships between the periosteal thickness and the muscle stiffness were assessed using Pearson correlations. RESULTS The shear wave velocity (SWV) of all lower leg muscles except the EDL was higher in the symptomless and MTSS groups than in the control group (TA, P = .001; PL, P = .006; SOL, P < .001; LG, P < .001; MG, P < .001; TP, P < .001; FDL, P = .013; and ANOVA). A significant difference was found in the SWV of the SOL, TP, and FDL between the control and symptomless groups (P = .041, P < .001, and P = .013, respectively). Moreover, the medial tibial periosteum was thickened after running training, and its thickness was positively correlated with muscle stiffness. CONCLUSION The medial tibia periosteal thickness is positively correlated with the lower leg muscles stiffness. Changes in SOL, TP, and FDL stiffness may be related to the occurrence of MTSS.
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Affiliation(s)
- Haixiang Zhang
- Department of Ultrasound, The Third Medical Centre of Chinese PLA General Hospital, The Training Site for Postgraduate of Jinzhou Medical University, Beijing, China
| | - Weiping Peng
- Department of Wounded and Sick Management, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Chi Qin
- Department of Ultrasound, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Yuqian Miao
- Department of Ultrasound, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Fan Zhou
- Department of Ultrasound, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Yutong Ma
- Department of Ultrasound, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Yongyan Gao
- Department of Ultrasound, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
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Akuzawa H, Oshikawa T, Nakamura K, Kubota R, Takaki N, Matsunaga N, Kaneoka K. Difference in the foot intersegmental coordination pattern between female lacrosse players with and without a history of medial Tibial stress syndrome; a cross-sectional study. J Foot Ankle Res 2022; 15:8. [PMID: 35101072 PMCID: PMC8802495 DOI: 10.1186/s13047-022-00513-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 01/23/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Medial tibial stress syndrome is a common sports related injury. Altered foot kinematics can be a risk factor for the injury. Since foot segments can move independently, intersegment coordination is important for proper foot function. This study aimed to compare the foot intersegmental coordination pattern and single segment kinematics between female lacrosse players with and without a history of medial tibial stress syndrome during drop jump.
Methods
Twelve players with a medial tibial stress syndrome history and 12 players with no history were enrolled. Foot kinematics, including angle at landing and peak angle and excursion at the rearfoot, midfoot, and forefoot during single-leg drop jumps were analysed. Each segment motion data from landing to leaping was time-scaled to 100% to analyse the intersegmental coordination with a modified vector coding technique. Instant intersegmental coordination of every 1% was classified into four patterns (in-phase, two segments rotate in the same direction with similar amplitudes; anti-phase, two segments rotate in opposite directions; proximal phase, proximal segment dominantly rotates in the same direction compared to the distal segment; and distal phase, distal segment dominantly rotates in the same direction compared to the proximal segment). The percentage of intersegmental coordination pattern and kinematics in each segment were compared between the groups using the Student’s t test.
Results
Groups with a history of medial stress syndrome showed a significantly higher percentage of proximal phase between the rearfoot and midfoot in the sagittal (Mean ± SD; history, 52.2 ± 17.9%, no history, 29.3 ± 16.7%; p = 0.004) and coronal planes (history, 40.3 ± 22.0%, no history, 15.9 ± 9.1%; p = 0.004). Dorsiflexion excursion (history, 34.5 ± 4.5°, no history, 29.6 ± 2.1°; p = 0.003) were significantly larger in a history of medial tibial stress syndrome group compared to no history group.
Conclusions
Rearfoot dominant motion pattern relative to the midfoot may be related to medial tibial stress syndrome. Intersegmental coordination analysis may be useful for detecting abnormal foot coordination patterns. Also, stabilization for the rearfoot may be required rather than the midfoot for intervention.
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Jardim RAC, Monteiro RL, Landre CB, Pegorari MS, Iosimuta NCR, Matos AP. Isokinetic ankle muscle strength is reduced in recreational runners with medial tibial stress syndrome and is not associated with pain. MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-657420220003122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Pulsone R, Williams C. Medial Tibial Stress Syndrome and Female Military Recruits. Health (London) 2022. [DOI: 10.4236/health.2022.143021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cha SM, Shin HD, Lee SH, Jin MG. Corrective osteotomy for malunion of distal diaphyseal/metaphyseal radius or ulna fracture affecting stability of the distal radioulnar joint. Injury 2021; 52:2300-2306. [PMID: 33832704 DOI: 10.1016/j.injury.2021.03.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND We postulated that residual distal radioulnar joint (DRUJ) instability after distal diaphyseal or metaphyseal fracture in the radius or ulna may occur due to malaligned or malunited bony structures as well as primary or secondary soft issue stabiliser. Here, we report the outcomes of corrective osteotomy in a retrospective study. METHODS Patients undergoing the osteotomy for DRUJ instability between March 2000 and February 2018 were included in the study. Thirteen patients were evaluated. The initial injury occurred at a mean age of 12.3 years and corrective osteotomy was performed at a mean age of 20.8 years. The mean follow-up period was 33.1 months. The male to female ratio was 8:5 and the corrected radius/ulna ratio was 11:2. DRUJ instability was diagnosed clinically and radiologically based on the stress/clunk test and the distance between the cortex of the radius, and the radioulnar ratio. All osteotomies in the radius and ulna were of the open wedge type and were performed using plates/screws. RESULTS The radioulnar ratio was significantly higher than the normal ratio (p < 0.001). All osteotomies healed well without any serious complications. The preoperative distance between the cortex of the radius and ulna was significantly decreased at the final follow-up, from 4.74 ± 0.82 to 1.16 ± 0.46 mm (p < 0.001). Positive findings of two instability tests were all converted to negative. The ranges of motion of the flexion-extension and pronation-supination arcs were significantly improved. Finally, preoperative VAS pain and DASH scores improved to 0.23 ± 0.44 and 3.92 ± 1.84, respectively (p < 0.001). CONCLUSIONS Malunited radius or ulna plays a role in DRUJ instability, affecting the bony geometry in terms of the relationship between the sigmoid notch and ulnar head. Treatment of malunion by corrective osteotomy represents a useful option for resolving instability. LEVEL OF EVIDENCE Level IV, Retrospective therapeutic study.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
| | - Seung Hoo Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Min Gyu Jin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Riegleman DL, Creech JA. Successful Treatment of Medial Tibial Stress Syndrome with Interosseous Membrane Acupuncture: A Case Series. Med Acupunct 2021; 33:150-152. [PMID: 33912272 DOI: 10.1089/acu.2020.1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Medial tibial stress syndrome (MTSS), otherwise known as shin splints, frequently causes pain and disability in the physically active population and can be recalcitrant to treatment. Interventional and alternative therapies, specifically acupuncture, for treatment of MTSS have been poorly described in the literature. The aim of this case series is to describe an acupuncture technique for the treatment of MTSS. Cases: Patients who received the diagnosis of MTSS were treated in an outpatient military treatment facility. One Hwato® 0.30 mm × 75 mm needle was placed 1 cun distal and 1 cun lateral to the tibial tuberosity of the affected leg and was inserted deeply through the plane of the interosseous membrane. A second needle was then placed 2 cun distal to the first needle in the same trajectory and at the same depth. Needles were then irregularly stimulated for 5 minutes before needle removal. After treatment, the patient vigorously moved the affected leg before reassessing pain. Results: Both patients noted a clinically significant decrease in pain immediately after intervention, which lasted for 4 weeks. Conclusions: Interosseous membrane acupuncture is a clinically significant, effective means to decrease MTSS-associated pain in physically active adults. This case series demonstrates a technique to augment conservative therapy of patients with MTSS.
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Affiliation(s)
- David Lee Riegleman
- SAUSHEC Pain Medicine Fellowship, Medical Education Department, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Julie A Creech
- Eglin Family Medicine Residency, 96th Medical Group, Eglin Air Force Base, FL, USA
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Cortés González RE. Successful treatment of medial tibial stress syndrome in a collegiate athlete focusing on clinical findings and kinesiological factors contributing to pain. Physiother Theory Pract 2020; 38:961-968. [PMID: 32757793 DOI: 10.1080/09593985.2020.1802798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Medial tibial stress syndrome (MTSS) is characterized by the presence of diffuse pain in the posteromedial portion of the medial border of the tibia. Current evidence from the literature has not established an effective treatment and has not been able to demonstrate effectiveness of numerous modalities commonly used to treat MTSS pain. CASE DESCRIPTION This report describes an 18-year-old male collegiate soccer player who presented with pain along the distal medial tibial border bilaterally consistent with the diagnosis of medial tibial stress syndrome (MTSS). Treatment focused on correcting clinical and kinesiological findings likely contributing to the patient's condition including fascial mobilization, interferential currents (IFC), strengthening and stretching exercises. After 10 sessions over 10 weeks the patient was able to return to training and competition without pain.
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Affiliation(s)
- Raúl Ernesto Cortés González
- Department of Physiotherapy, University of Soccer and Sports Sciences, Hidalgo, Mexico.,Department of Physiotherapy, National School of Higher Studies, Leon Unit, National Autonomous University of Mexico, Guanajuato, Mexico
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Whittle RS. Distance travelled by military recruits during basic training is a significant risk factor for lower limb overuse injury. BMJ Mil Health 2020; 168:343-348. [PMID: 32487672 DOI: 10.1136/bmjmilitary-2020-001445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Military initial training results in a high incidence of lower limb overuse injuries (stress fractures and medial tibial stress syndrome). This study aimed to determine whether the distance travelled by recruits, both on and off duty, was a risk factor for overuse injury. METHODS 14 male airborne infantry recruits from three training platoons carried global positioning system receivers throughout the first 19 weeks of basic military training. Total distance travelled each day was recorded. This was compared with time of clinical manifestation of 52 lower limb overuse injuries (stress fractures and medial tibial stress syndrome) collected from the 276 airborne infantry recruits in the period immediately preceding the study. RESULTS Recruits travelled significantly farther than the UK average male population in 17 of 18 measured weeks. Pearson correlation between distance travelled per week and injuries was not significant (p=0.4448); however, correlation between distance travelled per week and injuries two weeks later was significant (p=0.0263). A generalised linear model found distance travelled as a significant covariate (p=0.0144) to the expected number of injuries two weeks later. CONCLUSION Recruits travel long distances during basic training, particularly in the first few weeks when they are not yet conditioned. This distance travelled is likely a contributing risk factor to the high incidence of overuse injuries seen during training, and strategies to reduce this distance should be explored.
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Affiliation(s)
- Richard S Whittle
- Department of Aerospace Engineering, Texas A&M University, College Station, Texas, USA .,British Army, London, UK
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Zmistowski B, Gutman M, Horvath Y, Abboud JA, Williams GR, Namdari S. Acromial stress fracture following reverse total shoulder arthroplasty: incidence and predictors. J Shoulder Elbow Surg 2020; 29:799-806. [PMID: 31629651 DOI: 10.1016/j.jse.2019.08.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/04/2019] [Accepted: 08/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increased use of reverse total shoulder arthroplasty (RTSA) has led to an understanding of unique complications such as acromial stress fractures (ASFs). The factors associated with ASFs are not fully known. This study investigates the incidence and predictors of ASFs following RTSA. METHODS All RTSAs performed at a single tertiary referral hospital were retrospectively reviewed. ASF findings were classified as a definitive acromial or scapular spine stress fracture based on radiographic findings or stress reaction based on clinical findings (pain and tenderness at the acromion or acromial spine) without radiographic changes. Preoperative and postoperative radiographs were reviewed for radiographic predictors of postoperative acromial stress pathology. Clinical factors and implant characteristics were also investigated. RESULTS Between September 2010 and January 2017, a total of 1170 RTSAs were performed, with 958 cases (81.9%) having at least 3 months' clinical follow-up (mean, 407 days; range, 90-1698 days). There were 40 ASFs (4.2%) and 61 acromial stress reactions (6.4%). For fractures and reactions, symptom onset averaged 8.8 and 7.3 months (P = .37), respectively, with durations of 4.5 and 2.9 months (P = .02), respectively, following RTSA. Independent predictors of acromial stress pathology were female sex, decreased change in deltoid length, and increased preoperative glenohumeral center-of-rotation medialization. CONCLUSION Acromion-related symptoms are common following RTSA. Female patients with increased preoperative center-of-rotation medialization had an increased incidence of ASFs. Although this study establishes which patients are at risk of ASFs, methods for prevention of ASFs in these patients remain unclear.
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Affiliation(s)
- Benjamin Zmistowski
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Gutman
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yael Horvath
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gerald R Williams
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Surena Namdari
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Nakamura M, Ohya S, Aoki T, Suzuki D, Hirabayashi R, Kikumoto T, Nakamura E, Ito W, Takabayashi T, Edama M. Differences in muscle attachment proportion within the most common location of medial tibial stress syndrome in vivo. Orthop Traumatol Surg Res 2019; 105:1419-1422. [PMID: 31575506 DOI: 10.1016/j.otsr.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/07/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The medial tibial stress syndrome is one of the most common causes of running-related injuries. The primary study objective was to observe the attachment proportion of flexor digitorum longus and soleus, at the most common location of medial tibial stress syndrome, using ultrasonography, on a large cohort of young males and females to evaluate for gender-based anatomical differences. The secondary objective of this study was to investigate the relationship between the anatomical features and medial tibial stress syndrome. METHODS In this study, we observed whether or not flexor digitorum longus and/or soleus attached at the middle and distal thirds of the medial margin of the tibia (most common location of medial tibial stress syndrome) using ultrasonography. History of medial tibial stress syndrome was defined by inquiries. RESULTS The Chi2 tests showed that the attachment proportion of the soleus in female participants was significantly higher than that observed in male participants. In addition, Chi2 testing showed that there were no significant differences between attachment proportion of soleus of legs with history of medial tibial stress syndrome and legs without history of medial tibial stress syndrome, in both male and female participants. CONCLUSIONS These results suggested that the anatomical features of flexor digitorum longus might be involved in medial tibial stress syndrome development, whereas the anatomical features of the soleus might not be involved in medial tibial stress syndrome development. LEVEL OF EVIDENCE III, cross-sectional study.
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Affiliation(s)
- Masatoshi Nakamura
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.
| | - Shuhei Ohya
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Takafumi Aoki
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Daichi Suzuki
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryo Hirabayashi
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Takanori Kikumoto
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Emi Nakamura
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Wataru Ito
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Tomoya Takabayashi
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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Rocha Piedade S, Hutchinson MR, Maffulli N. Presently PROMs are not tailored for athletes and high-performance sports practitioners: a systematic review. J ISAKOS 2019. [DOI: 10.1136/jisakos-2019-000286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Winters M, Burr DB, van der Hoeven H, Condon KW, Bellemans J, Moen MH. Microcrack-associated bone remodeling is rarely observed in biopsies from athletes with medial tibial stress syndrome. J Bone Miner Metab 2019; 37:496-502. [PMID: 30066165 DOI: 10.1007/s00774-018-0945-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/18/2018] [Indexed: 01/31/2023]
Abstract
The pathology of medial tibial stress syndrome (MTSS) is unknown. Studies suggest that MTSS is a bony overload injury, but histological evidence is sparse. The presence of microdamage, and its potential association with targeted remodeling, could provide evidence for the pathogenesis of MTSS. Understanding the pathology underlying MTSS could contribute to effective preventative and therapeutic interventions for MTSS. Our aim was to retrospectively evaluate biopsies, previously taken from the painful area in athletes with MTSS, for the presence of linear microcracks, diffuse microdamage and remodeling. Biopsies, previously taken from athletes with MTSS, were evaluated at the Department of Anatomy and Cell Biology at the Indiana University. After preparing the specimens by en bloc staining, one investigator evaluated the presence of linear microcracks, diffuse microdamage and remodeling in the specimens. A total of six biopsies were evaluated for the presence of microdamage and remodeling. Linear microcracks were found in 4 out of 6 biopsies. Cracking in one of these specimens was artefactual due to the biopsy procedure. No diffuse microdamage was seen in any of the specimens, and only one potential remodeling front in association with the microcracks. We found only linear microcracks in vivo in biopsies taken from the painful area in 50% of the athletes with MTSS, consistent with the relationship between linear cracks and fatigue-associated overloading of bone. The nearly universal absence of a repair reaction was notable. This suggests that unrepaired microdamage accumulation may underlie the pathophysiological basis for MTSS in athletes.
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Affiliation(s)
- Marinus Winters
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, 9220, Aalborg, Denmark.
| | - David B Burr
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, USA
- Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, USA
| | | | - Keith W Condon
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, USA
| | - Johan Bellemans
- Department of Orthopedics, University Hasselt, ZOL Hospital Genk, Genk, Belgium
| | - Maarten H Moen
- Bergman Clinics, Naarden, The Netherlands
- The Sportsphysician Group, OLVG Hospital Amsterdam, Amsterdam, The Netherlands
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Tibial stress injuries - location, severity, and classification in magnetic resonance imaging examination. Pol J Radiol 2019; 83:e471-e481. [PMID: 30655927 PMCID: PMC6334187 DOI: 10.5114/pjr.2018.80218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/06/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe and illustrate the spectrum of magnetic resonance imaging (MRI) findings of tibial stress injuries (TSI) and propose a simplified classification system. Material and methods Retrospective analysis of MRI exams of 44 patients with clinical suspicion of unilateral or bilateral TSI, using a modified classification system to evaluate the intensity and location of soft-tissue changes and bone changes. Results Most of the patients were young athletic men diagnosed in late stage of TSI. Changes were predominantly found in the middle and distal parts of tibias along medial and posterior borders. Conclusions TSI may be suspected in young, healthy patients with exertional lower leg pain. MRI is the only diagnostic method to visualise early oedematic signs of TSI. Knowledge of typical locations of TSI can be helpful in proper diagnosis before its evolution to stress fracture.
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Rubin DA. MRI of Sports Injuries in the Leg. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Newman P, Waddington G, Adams R. Shockwave treatment for medial tibial stress syndrome: A randomized double blind sham-controlled pilot trial. J Sci Med Sport 2017; 20:220-224. [DOI: 10.1016/j.jsams.2016.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/19/2016] [Accepted: 07/13/2016] [Indexed: 02/02/2023]
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Winters M, Bakker EWP, Moen MH, Barten CC, Teeuwen R, Weir A. Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. Br J Sports Med 2017; 52:1267-1272. [DOI: 10.1136/bjsports-2016-097037] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 12/12/2022]
Abstract
BackgroundThe majority of sporting injuries are clinically diagnosed using history and physical examination as the cornerstone. There are no studies supporting the reliability of making a clinical diagnosis of medial tibial stress syndrome (MTSS).AimOur aim was to assess if MTSS can be diagnosed reliably, using history and physical examination. We also investigated if clinicians were able to reliably identify concurrent lower leg injuries.MethodsA clinical reliability study was performed at multiple sports medicine sites in The Netherlands. Athletes with non-traumatic lower leg pain were assessed for having MTSS by two clinicians, who were blinded to each others’ diagnoses. We calculated the prevalence, percentage of agreement, observed percentage of positive agreement (Ppos), observed percentage of negative agreement (Pneg) and Kappa-statistic with 95%CI.ResultsForty-nine athletes participated in this study, of whom 46 completed both assessments. The prevalence of MTSS was 74%. The percentage of agreement was 96%, with Ppos and Pneg of 97% and 92%, respectively. The inter-rater reliability was almost perfect; k=0.89 (95% CI 0.74 to 1.00), p<0.000001. Of the 34 athletes with MTSS, 11 (32%) had a concurrent lower leg injury, which was reliably noted by our clinicians, k=0.73, 95% CI 0.48 to 0.98, p<0.0001.ConclusionOur findings show that MTSS can be reliably diagnosed clinically using history and physical examination, in clinical practice and research settings. We also found that concurrent lower leg injuries are common in athletes with MTSS.
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Sports Injuries: Misinterpretations to Learn From. J Belg Soc Radiol 2016. [PMCID: PMC6100417 DOI: 10.5334/jbr-btr.1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Athletes present with a variety of both common and specific injuries to the sports physician. For the imaging evaluation of such injuries, this poses special problems to avoid misinterpretations. While some sports injuries are not complicated, other are initially misdiagnosed, leading to possible secondary complications. Further, seemingly abnormal imaging findings in athletes can actually be normal physiological and mechanical phenomenons. Especially in young athletes, a variety of pitfalls are encountered at imaging, such as a focal periphyseal edema or a cortical desmoid. Good communication between the sports physician and the radiologist is paramount in reaching a fast and correct diagnosis in such cases.
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Zimmermann WO, Helmhout PH, Beutler A. Prevention and treatment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch Armed Forces. J ROY ARMY MED CORPS 2016; 163:94-103. [DOI: 10.1136/jramc-2016-000635] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/26/2016] [Accepted: 05/29/2016] [Indexed: 01/28/2023]
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Lucas SJE, Helge JW, Schütz UHW, Goldman RF, Cotter JD. Moving in extreme environments: extreme loading; carriage versus distance. EXTREME PHYSIOLOGY & MEDICINE 2016; 5:6. [PMID: 27110357 PMCID: PMC4840901 DOI: 10.1186/s13728-016-0047-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/01/2016] [Indexed: 12/17/2022]
Abstract
This review addresses human capacity for movement in the context of extreme loading and with it the combined effects of metabolic, biomechanical and gravitational stress on the human body. This topic encompasses extreme duration, as occurs in ultra-endurance competitions (e.g. adventure racing and transcontinental races) and expeditions (e.g. polar crossings), to the more gravitationally limited load carriage (e.g. in the military context). Juxtaposed to these circumstances is the extreme metabolic and mechanical unloading associated with space travel, prolonged bedrest and sedentary lifestyle, which may be at least as problematic, and are therefore included as a reference, e.g. when considering exposure, dangers and (mal)adaptations. As per the other reviews in this series, we describe the nature of the stress and the associated consequences; illustrate relevant regulations, including why and how they are set; present the pros and cons for self versus prescribed acute and chronic exposure; describe humans' (mal)adaptations; and finally suggest future directions for practice and research. In summary, we describe adaptation patterns that are often U or J shaped and that over time minimal or no load carriage decreases the global load carrying capacity and eventually leads to severe adverse effects and manifest disease under minimal absolute but high relative loads. We advocate that further understanding of load carrying capacity and the inherent mechanisms leading to adverse effects may advantageously be studied in this perspective. With improved access to insightful and portable technologies, there are some exciting possibilities to explore these questions in this context.
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Affiliation(s)
- Samuel J. E. Lucas
- />School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, B15 2TT UK
- />Department of Physiology, University of Otago, Dunedin, New Zealand
| | - Jørn W. Helge
- />Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Uwe H. W. Schütz
- />Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany
- />Orthopaedic Consulting Office at the Green Tower and Medical Pain Centre Lake Constance–Upper Swabia, Ravensburg, Germany
| | | | - James D. Cotter
- />School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
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Zhang H, Merrett DC, Jing Z, Tang J, He Y, Yue H, Yue Z, Yang DY. Osteoarchaeological Studies of Human Systemic Stress of Early Urbanization in Late Shang at Anyang, China. PLoS One 2016; 11:e0151854. [PMID: 27050400 PMCID: PMC4822842 DOI: 10.1371/journal.pone.0151854] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/04/2016] [Indexed: 11/19/2022] Open
Abstract
Through the analysis of human skeletal remains and mortuary practice in Yinxu, this study investigates the impact of early urbanization on the commoners during the Late Shang dynasty (ca. 1250-1046 B.C.). A total of 347 individuals examined in this study represent non-elites who were recovered from two different burial contexts (formally buried in lineage cemeteries and randomly scattered in refuse pits). Frequencies of enamel hypoplasia (childhood stress), cribra orbitalia (childhood stress and frailty) and osteoperiostitis (adult stress) were examined to assess systemic stress exposure. Our results reveal that there was no significant difference in the frequency of enamel hypoplasia between two burial groups and between sexes, suggesting these urban commoners experienced similar stresses during childhood, but significantly elevated levels of cribra orbitalia and osteoperiostitis were observed in the refuse pit female cohort. Theoretically, urbanization would have resulted in increased population density in the urban centre, declining sanitary conditions, and increased risk of resource shortage. Biologically, children would be more vulnerable to such physiological disturbance; as a result, high percentages of enamel hypoplasia (80.9% overall) and cribra orbitalia (30.3% overall) are observed in Yin commoners. Adults continued to suffer from stress, resulting in high frequencies of osteoperiostitis (40.0% total adults); in particular, in the refuse pit females who may also reflect a compound impact of gender inequality. Our data show that the non-elite urban population in the capital city of Late Shang Dynasty had experienced extensive stress exposure due to early urbanization with further social stratification only worsening the situation, and eventually contributing to collapse of the Shang Dynasty.
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Affiliation(s)
- Hua Zhang
- Department of Archaeology, Simon Fraser University, Burnaby, British Columbia, Canada
- SFU-JLU Joint Centre for Bioarchaeological Research, Department of Archaeology, Simon Fraser University, Burnaby, British Columbia, Canada
- * E-mail: (HZ); (DY); (ZJ)
| | - Deborah C. Merrett
- Department of Archaeology, Simon Fraser University, Burnaby, British Columbia, Canada
- SFU-JLU Joint Centre for Bioarchaeological Research, Department of Archaeology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Zhichun Jing
- Department of Anthropology, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail: (HZ); (DY); (ZJ)
| | - Jigen Tang
- Institute of Archaeology, Chinese Academy of Social Sciences, Beijing, China
| | - Yuling He
- Institute of Archaeology, Chinese Academy of Social Sciences, Beijing, China
| | - Hongbin Yue
- Institute of Archaeology, Chinese Academy of Social Sciences, Beijing, China
| | - Zhanwei Yue
- Institute of Archaeology, Chinese Academy of Social Sciences, Beijing, China
| | - Dongya Y. Yang
- Department of Archaeology, Simon Fraser University, Burnaby, British Columbia, Canada
- SFU-JLU Joint Centre for Bioarchaeological Research, Department of Archaeology, Simon Fraser University, Burnaby, British Columbia, Canada
- * E-mail: (HZ); (DY); (ZJ)
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